Major pancreatic cancer breakthrough brings new hope

A major laboratory breakthrough has offered hope of new treatments for pancreatic cancer.

Researchers at Glasgow University have identified four key subtypes of pancreatic cancer, each with their own distinct clinical characteristics and differential survival outcomes.

Pancreatic cancer is currently the fourth leading cause of cancer death in Western societies, and is projected to be the second most common within a decade.

The new research, published in the journal Nature, has named the four subtypes as Squamous, Pancreatic Progenitor, Immunogenic and ADEX, short for Aberrantly Differentiated Endocrine eXocrine.

The groups were categorised based on figures from the Australian Pancreatic Cancer Genome Initiative after examining key aspects of pancreatic tumours.

Currently people with pancreatic cancer have a poor prognosis, with a median survival measured in just months and a five year survival rate of less than five per cent.

The disease progresses “silently” within the pancreas for up to 15 to 20 years, until patients present to the clinic when they are in the later stages of the disease. From those who are diagnosed with the disease only a small number can have their tumour affected by treatment.

Researchers say the current methods of treating pancreatic cancer are not targeted or selective and have been described as “hitting the disease with a mallet with your eye closed”.

They hope that the new reclassification will help to identify the correct targeted treatment for each individual subtype of the disease.

Study co-leader Professor Andrew Biankin said: “There is an urgent need to better understand the molecular pathology of pancreatic cancer in order to improve patient selection for current treatment options, and to develop novel therapeutic strategies.

“The four subtypes that we have identified represent a reclassification of the disease and as such should provide a basis to offer new insights into personalised therapeutic options for individual patients and a launch pad to investigate new treatments.”

He said one of the key findings was the identification of the immunogenic subtype, which the study found could potentially prove to be responsive to types of immunotherapeutic cancer treatments.

Prof Biankin said: “The novel immunogenic subtype of pancreatic cancer is characterised by specific mechanisms that can potentially be targeted using immune modulators, and testing in clinical trials is encouraged.”

First author Dr Peter Bailey said: “The standard of care for pancreatic cancer really hasn’t changed in the last 20 years.

“There are a number of different chemotherapeutic options but in general it’s not very selective - it’s like hitting the disease with a mallet with your eyes closed.

“The work that we are doing is about trying to change the clinical landscape for, not only pancreatic cancer, but all cancers by providing a very thorough analysis of the molecular pathology of specific cancers, leading to a more personalised or precise approach to treatment based on the underlying genetic defects that drive a cancer that may be vulnerable to specific drugs.”

Dr Emma Smith, senior science information officer at Cancer Research UK, said: “Identifying different types of pancreatic cancer and revealing the disease’s complexity is an important step towards finding more effective treatments.

“This will help to ensure patients are given the therapies that are most likely to help.

“Improving survival for people with pancreatic cancer is one of our top priorities, and we urgently need more research like this if we’re going to beat this disease in the future.”